BMC Health Services Research最新文献

{"title":"Structural barriers in the prevention and control of leptospirosis in a municipality in Southern Brazil: a qualitative study.","authors":"Suellen Caroline M Silva, Bianca Conrad Bohm, Ravena Dos Santos Hage, Alessandra Talaska Soares, Julia Somavilla Lignon, Jackeline Vieira Lima, Alessandra Jacomelli Teles, Juliana Graciela Vestena Zillmer, Fábio Raphael Pascoti Bruhn","doi":"10.1186/s12913-025-13373-6","DOIUrl":"10.1186/s12913-025-13373-6","url":null,"abstract":"<p><strong>Background: </strong>This article aimed to describe the structural barriers to the prevention and control of leptospirosis in a municipality in southern Brazil.</p><p><strong>Methodology: </strong>A qualitative approach, specifically a case study design, was employed in this study conducted within primary care, surveillance, and management settings of a municipality. Thirty-three workers were selected through purposive sampling, and semi-structured individual interviews were conducted from August 2022 to March 2023. Data analysis followed a thematic sequential approach managed using the Etnograph program.</p><p><strong>Results: </strong>Five categories describing the barriers emerged from the results. The first barrier refers to knowledge of leptospirosis and preventive measures, the second to the lack of training, the third to insufficient infrastructure, the fourth to inadequate human resources, and the fifth to the absence of information production and notification protocols. Through the identification of these barriers, it was possible to highlight local bottlenecks in providing access to healthcare and addressing the demand for leptospirosis cases.</p><p><strong>Conclusions: </strong>While the results may not be representative of the entire national territory, they can serve as a starting point for further studies on leptospirosis, prompting inquiries into its impact in areas with high disease risk and fostering the development of interventions on a larger scale.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1234"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of implementation science frameworks to identify core components and sustainability characteristics of a quality improvement learning collaborative.","authors":"Deborah A McNamara, Peter E Lonergan, Paul Rafferty, Fidelma Fitzpatrick, Catherine Hayes","doi":"10.1186/s12913-025-13346-9","DOIUrl":"10.1186/s12913-025-13346-9","url":null,"abstract":"<p><strong>Background: </strong>Implementation Science (IS) frameworks facilitate definition of core and optional components of innovations, interventions and programmes, which increases the likelihood of successful implementation and sustainment. We used IS frameworks to characterise a hospital-based interdisciplinary quality improvement learning collaborative (QILC) which was established to develop quality improvement (QI) capability among front-line staff. The aim was to identify factors that supported implementation, potential threats to sustainability and elements that may influence dissemination into other settings.</p><p><strong>Methods: </strong>Of five IS frameworks evaluated, two were selected, the Active Implementation Framework (action-oriented, dependent on feedback loops and improvement cycles) and the Consolidated Framework for Implementation Research (enabled definition of core components). The QILC was mapped against the drivers and constructs of each.</p><p><strong>Results: </strong>Factors relating to the QILC's leadership; the generation of tension for change; and the use of both internal and external networks were central features in implementation. Key drivers included the characteristics of front-line ownership, iterative development and tribality of the QILC, each being central to QI methodology. Risks to sustainability included patchy implementation, a requirement for greater alignment with organisational priorities, requirement for coaching and recruitment of additional leaders to support succession planning.</p><p><strong>Conclusions: </strong>IS provided frameworks for retrospective analysis of a QI learning collaborative and identified factors that threaten sustainability. This analysis should help guide formative evaluations of similar QI learning collaboratives and offer an organisational framework to facilitate successful replication within different parts of an organisation and across multiple settings.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1257"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of family medicine physician associates/assistants in the United States.","authors":"Bethany Grubb, Cynthia F Griffith, Mirela Bruza-Augatis, Kasey Puckett, Andrzej Kozikowski","doi":"10.1186/s12913-025-13355-8","DOIUrl":"10.1186/s12913-025-13355-8","url":null,"abstract":"<p><strong>Background: </strong>The family medicine (FM) workforce in the United States (U.S.) includes physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). These family medicine practitioners are patients' first point of contact, providing preventative, continuous healthcare, care coordination, and patient-centered care. Yet, despite their importance in the healthcare system, the shortage of FM practitioners persists. Considering the general medical education of PAs and limited research on their roles in FM, this research aims to understand the employment characteristics of this professional group.</p><p><strong>Methods: </strong>This cross-sectional observational research utilized a 2023 national dataset from the National Commission on Certification of PAs (NCCPA). We used standard descriptive and bivariate analyses to summarize the demographic and professional attributes of PAs in FM (n = 20,940) versus those in all other specialties (n = 106,001).</p><p><strong>Results: </strong>In 2023, 16.5% of PAs indicated working in FM. PAs in FM had a median age of 41, and 68.8% self-identified as female. PAs in FM versus those in other medical specialties (all p < 0.001) were more likely to self-identify as Black/African American (3.8% versus 3.4%) and Hispanic/Latino(a/x) (9.3% versus 6.6%). A higher ratio of PAs in FM indicated practicing in rural/isolated settings (15.3% versus 5.7%) and reported using another language other than English to communicate with patients (26.4% versus 21.7%; all p < 0.001) than their colleagues in other medical specialties. FM PAs were more likely to indicate working in office-based private settings, community health centers, rural health clinics, and public/community health clinics than PAs in all other specialties. Compared to their colleagues in other specialties, a higher percentage of PAs in FM indicated providing telemedicine services (66.1% versus 38.1%; p < 0.001). Family medicine PAs versus those in other medical disciplines reported earning $10,000 less (annual income). A slightly lower proportion of PAs in FM reported being satisfied with their current employment and were more likely to experience symptoms of burnout compared to PAs in other medical specialties.</p><p><strong>Conclusions: </strong>This study reinforces the critical role of PAs in FM in mitigating the healthcare access crisis, particularly in underresourced and rural areas. A better understanding of factors associated with PAs pursuing and sustaining practice in FM could alleviate some of the burden of the projected healthcare provider shortage in primary care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1220"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralization of hepatitis B care in sub-Saharan Africa: study protocol for a prospective cohort assessing three models of care in rural Ethiopia.","authors":"Kristian Braathen Malme, Nega Berhe, Fufa Hunduma, Hailemichael Desalegn, Asgeir Johannessen","doi":"10.1186/s12913-025-13340-1","DOIUrl":"10.1186/s12913-025-13340-1","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1223"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative evaluation of China's new health insurance payment policy based on the policy modeling consistency (PMC) index model.","authors":"Chengxin Fan, Xiaochun Li, Jiahui Liu, Yifan Wang, Mengjiao Yang, Wenqiang Yin","doi":"10.1186/s12913-025-13380-7","DOIUrl":"10.1186/s12913-025-13380-7","url":null,"abstract":"<p><strong>Background: </strong>Establishing an efficient health insurance payment mechanism is a core objective of China's healthcare reform. The Chinese government has introduced numerous policy documents to refine the health insurance payment system. However, research on these new payment methods primarily relies on economic analysis such as cost-effectiveness and econometric studies, and has not systematically assessed the internal design and consistency of policy texts.</p><p><strong>Methods: </strong>This study uses text mining methods and the Policy Modeling Consistency (PMC) Index model to construct a policy evaluation framework, which includes 9 primary variables and 39 secondary variables. The framework is used to conduct a quantitative evaluation of China's new health insurance payment policies.</p><p><strong>Results: </strong>The themes of China's new Health insurance payment policies are focused and continuously refined. Quantitative results from the PMC Index model show that the overall policy design is reasonable, although significant differences exist among them. Of the 9 policies, 1 is rated excellent, 4 are rated good, and 4 are rated acceptable.</p><p><strong>Conclusions: </strong>The overall evaluation of health insurance payment policies is positive, though there is room for optimization between individual policies. Strengthening top-level design, improving policy effectiveness, timeliness, and the use of policy tools, as well as promoting localized and standardized reforms, are crucial to fostering high-quality development in healthcare.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1255"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care worker experiences with a brief peer support and well-being intervention during the COVID-19 pandemic.","authors":"George Timmins, Stephanie Williamson, Andrea Cassells, Katie Davis, Lu Dong, Jonathan N Tobin, Courtney Gidengil, Lisa S Meredith, Peggy G Chen","doi":"10.1186/s12913-025-13268-6","DOIUrl":"10.1186/s12913-025-13268-6","url":null,"abstract":"<p><strong>Importance: </strong>Health care workers (HCW) faced chronic stress during the COVID-19 pandemic and were at high risk of illness, death and burnout.</p><p><strong>Objective: </strong>To understand the experiences of and assess the acceptability and usability of the \"Stress First Aid\" (SFA) intervention for HCWs.</p><p><strong>Design: </strong>We used a mixed methods approach to conduct: (1) a quantitative post-intervention survey of experiences with the SFA intervention within a cluster randomized controlled trial (cRCT); and (2) a qualitative descriptive analysis. The intervention was rolled out over three waves from March 2021 - October 2022 simultaneously with the sites' COVID-19 response.</p><p><strong>Setting: </strong>Our team engaged and recruited eight pairs of hospitals and six pairs of Federally Qualified Health Centers (FQHCs), balanced across region, including nine states, and matched on size, type, and COVID-19 burden.</p><p><strong>Participants: </strong>A total of 862 HCWs received the SFA intervention and completed both the pre- and post-intervention surveys (FQHC n = 245 and hospital n = 617). For the qualitative analysis, among HCWs who agreed to be contacted for a post-intervention interview, we purposively sampled a subset of 35 HCWs balanced by site, gender, age, race/ethnicity and HCW type.</p><p><strong>Intervention: </strong>SFA is an evidence-informed intervention adapted to mitigate the psychosocial impact of COVID-19 on HCWs through individual peer support actions.</p><p><strong>Main outcome(s) and measure(s): </strong>Quantitative measures are binary indicators of agreement with 6 questions about experiences with the SFA intervention. For the qualitative analysis, we utilized a semi-structured interview protocol to provide additional context on experience with SFA and how SFA affects HCW well-being.</p><p><strong>Results: </strong>Between 48.2 and 59.4% of HCWs agreed or strongly agreed that they: found SFA helpful (48.2%), felt comfortable supporting colleagues (59.4%), would recommend SFA (51.2%), and would continue to use SFA principles (57.2%). Non-White HCWs (particularly Black HCWs), those in assistant/technician positions and those who reported attending a greater number of booster sessions were more likely to agree with positive statements about SFA experiences.</p><p><strong>Conclusions and relevance: </strong>Given the continued resurgence of public health emergencies, its lasting effects on HCWs, and related emerging challenges, we expect there to be a continued need for support of patient-facing HCWs.</p><p><strong>Clinical trial registration: </strong>Clinical Trials.gov Number: NCT04723576 Registered on 01/22/2021 Clinicaltrials.govNCT04723576.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1253"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of nurses' perceptions of systems thinking on patient safety competencies: a cross-sectional study.","authors":"Edris Kakemam, Abbas Mardani, Elnaz Parsarad, Rohangiz Taheri, Saeideh Moosavi, Rohollah Kalhor, Young Sook Roh","doi":"10.1186/s12913-025-13456-4","DOIUrl":"10.1186/s12913-025-13456-4","url":null,"abstract":"<p><strong>Background: </strong>Systems thinking-conceptualized as an approach for understanding the dynamic interactions and interdependencies among components within complex systems such as healthcare-has been widely recognized in the literature as a critical framework for strengthening patient safety competencies (PSCs). Despite this recognition, empirical studies specifically examining the impact of systems thinking on nurses' PSCs remain limited. Accordingly, the present study aims to examine the relationship between systems thinking and PSCs among Iranian nurses.</p><p><strong>Methods: </strong>This study employed a cross-sectional descriptive design with a simple random sample of 400 nurses working in teaching hospitals in Qazvin, Iran between August and November 2024. Data were collected using the valid scales including, Systems Thinking Scale and the Patient Safety Competency Self-Evaluation tool for assessing perceptions of nurses towards systems thinking and PSCs, respectively. Data were analyzed using the independent sample t-test, ANOVA‌, and multiple linear regression.</p><p><strong>Results: </strong>The mean score for systems thinking and PSCs was 56.77 ± 12.24 out of 80 and 3.65 ± 0.54 out of 5, respectively. A positive correlation was found between systems thinking and PSCs scores (r = .583, p < .001). The findings of multiple linear regression analysis indicated that the level of systems thinking significantly predicted PSCs after control demographic and professional characteristics as potential confounders (R² = 0.355; B = 0.026, 95% CI = 0.022 to 0.029; p < .001).</p><p><strong>Conclusion: </strong>Nurses in the study population demonstrated moderate levels of both systems thinking and PSCs. These findings underscore the critical role of systems thinking in enhancing nurses' PSCs. The results can serve as a foundational basis for the formulation of hospital policies aimed at bolstering nurses' PSCs, thereby contributing to improved patient safety within healthcare settings. Policies and interventions on promoting systems thinking among nursing staff must be created and implemented. However, further studies using robust designs, including longitudinal and intervention research designs, are needed to examine the effect of systems thinking to enhance PSCs in nurses working in hospitals.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1233"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between population level social risk factors and prevalence of diabetes.","authors":"Leonard E Egede, Rebekah J Walker, Sebastian Linde","doi":"10.1186/s12913-025-13479-x","DOIUrl":"10.1186/s12913-025-13479-x","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this study was to evaluate the relationship between population level social risk and diabetes prevalence using US census tract data.</p><p><strong>Methods: </strong>We combined data from the CDC PLACES 2019 database and the Opportunity Insights database. Multiple linear regression was run with standardized estimates to investigate incarceration, poverty, housing, education, employment, job environment, economic mobility, and healthcare access as independent correlates of diabetes prevalence at the census tract, adjusting for US population and state fixed effects.</p><p><strong>Results: </strong>The final analytic sample consisted of 11,457 census tracts within 157 counties in 38 states. Mean prevalence of diabetes was 11.8%. Healthcare access variables had the strongest association with every standard deviation (SD) increase in proportion with an annual check-up or proportion uninsured, associated with crude prevalence increase of 0.7 or 0.5 SD, respectively. Social risk factors were significant with poverty (every SD increase in income below the poverty line in the full model), housing (every SD increase in average rent for a two-bedroom apartment), and education (every SD increase in proportion of residents with a college degree) each associated with a 0.1 SD increase in crude prevalence of diabetes, and incarceration associated with 0.05 SD increase. Crude prevalence of diabetes varied across states.</p><p><strong>Conclusions: </strong>The strongest drivers of prevalence of diabetes at the census tract were healthcare access, measured by insurance and having a usual source of care, income, housing, education, and incarceration. Efforts are needed to improve healthcare access while also addressing social risk at the neighborhood level.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1252"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the maternal sepsis patient journey in Malawi: \"I called for help, but they showed no interest in helping me\".","authors":"Yamikani Chimwaza, Chikondi Chapuma, Chifundo Ndamala, Emily Lifa, Mercy Machilika, Bernard Dossie, Meliya Kwelepeta, Bertha Maseko, David Lissauer, Alinane Linda Nyondo-Mipando, Maria Lisa Odland","doi":"10.1186/s12913-025-13459-1","DOIUrl":"10.1186/s12913-025-13459-1","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1246"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Where will we find them?\" They are just like droppings : Perceptions of health care workers regarding access to health promotion among urban migrants in Botswana.","authors":"Galekgatlhe Bailey Balekang, Treasa Galvin, Daniel Serai Rakgoasi","doi":"10.1186/s12913-025-13444-8","DOIUrl":"10.1186/s12913-025-13444-8","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"1232"},"PeriodicalIF":3.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}